| Generic (& other names) | Brand name | Classification |
| indiinavir | Crixivan | protease inhibitor |
| Dosage, usual for adults | 800 mg orally every 8 hours (Two 400 mg or four 200 mg capsules for each dose.) |
| Storage | Room temperature. Tightly closed bottle. Capsules are sensitive to moisture and should be dispensed in the original container. The desiccant should remain in the original container |
| Note | This medication is taken three times a day, and it must be taken at intervals of 8 hours. |
| Enhancing drug levels |
- For optimal absorption, indinavir should be administered on an empty stomach. That is, without food but with water 1 hour before a meal or 2 hours after a meal, or in other words: two hours after you finish eating, take the medication, then wait for one more hour until you eat again.
- In early studies on HIV negative subjects, a light snack was shown to not change absorption levels.
- Essentially these snacks should be low in fat and protein:
- - Less than 2 grams, of fat
- - Less than 5.6 grams of protein
- - Less than 65 grams of carbohydrate
- - Less than 300 calories
- The following two choices were the only foods that were approved to be considered the light snack and appears on the package insert. One must be cautious, however, since no serving sizes were designated for these food choices on the package inserts. Using the above calorie, protein, fat and carbohydrate information, we can now assign portion sizes:
- - 1 slice dry toast with 2 tablespoons jelly, 1 cup juice (not grapefruit juice), and 1 cup coffee with 2 tablespoons skim milk and 1 teaspoon sugar.
- - 1 cup dry corn flakes with 1/2 cup skim milk and 1-2 teaspoons sugar
- (1%, 2% or whole milk are not options )
- In August, 1997 the FDA approved an Additional Food List developed by the HIV/AIDS Dietetic Practice Group of The American Dietetic Association. This list of 40 light snack ideas follows the ranges given above.
- Talk with your primary care provider about taking light snacks with this medication. Examples of light snacks that fit that macronutrient profile are:
- - 2 Fig Newtons, 1 cup fruit juice (not coconut or grapefruit)
- - 1/2 cup dry cereal (ex. Corn Flakes, Cheerios, Cocoa Puffs, Life, Golden Grahams, but none that have nuts, seeds or granola or other high fat foods), 1/2 cup skim milk
- - 1/2 cup rice, 1 small corn tortilla, 2 tablespoons of salsa.
- - 1/2 Power Bar, 1 cup Gatorade.
- There are more feeding and fasting studies underway. At the time, the best choice seems to be to taking the medication on an empty stomach, or using the Additional Food List recommendations.
- Timing of medication must be every 8 hours. Set up your medication schedule by choosing one of the following set of times:
Dose 1 Dose 2 Dose 3
6:00am 2:00pm 10:00pm
7:00am 3:00pm 11:00pm
8:00am 4:00pm 12:00am
9:00am 5:00pm 1:00am
10:00am 6:00pm 2:00am
11:00am 7:00pm 3:00am
12:00pm 8:00pm 4:00am
1:00pm 9:00pm 5:00am
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| Reducing drug levels |
- Absorption is reduced with a full meal. The manufacturer's information states not to take indinavir with foods high in fat, protein, calories, and gives an example of a poor meal choice as a bacon and egg breakfast. The clinical study showed a significant reduction in absorption when subjects consumed a meal consisting of:
- 784 calories
- 31.8 g protein
- 31.1 g fat
- AVOID drinking grapefruit juice. Grapefruit juice decreases levels of indinavir by 26%.
- Missing doses or taking drug holidays drastically reduces drug levels.
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| Possible meal / med schedule |
4-6 AM : No food (sleeping)
6 AM : Indinavir
6-7 AM : No food
7 AM : Breakfast
10 AM : Snack
11:30-12 noon : Lunch
12 noon-2 PM : No food
2 PM : Indinavir
2-3 PM : No food
3 or 4 PM : Snack
7-8 PM : Supper
8-10 PM : No food
10 PM : Indinavir
10-11 PM : No food
11 PM : Bedtime Snack
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| Fluids |
- Physicians and registered dietitians strongly recommend drinking at least 10-12 cups (80-96 ounces) per day.
- Why? Fluids are needed to REDUCE the risk of kidney stones, which are caused by crystals of the medication.
- WATER! While the package insert indicates that indinavir may be taken with skim milk, juice, coffee or tea, safe water appears to be the best choice at this time. Safe water is water that has been brought to a rapid boil for 1 minute, or is distilled, or has gone through a filter meeting NSF standard 53 for cyst reduction. Bottled water, unless it meets these guidelines, or water from a vending machine is not guaranteed to be safe.
- Coffee! While package insert indicates indinavir can be taken with coffee, caffeine in coffee and other foods can speed up the gastrointestinal tract, creating looser stools with a potential fluid loss from both excretion and urination. Also, many people experience a reduction of appetite after caffeine containing foods. Watch that you don't skip meals or snacks when you have the opportunity to eat. With three periods in the day when someone on this medication should not eat or eat very little, watch that you don't skip meals or snacks when you have the opportunity to eat.
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| Common reactions that may affect nutritional status |
| Specifically |
- About 4% of patients in clinical studies reported kidney stones. 2% or less of patients reported abdominal pain, fatigue or weakness, flank pain, feeling unwell, nausea, diarrhea, vomiting, acid regurgitation, loss of appetite, dry mouth, back pain, trouble sleeping, taste changes, rash, upper respiratory infection, dry skin, and sore throat.
- Watch for any symptoms of high blood sugar (high blood glucose)
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| Generally |
- Tell your primary care provider if and when anything abnormal occurs to determine what is its actual cause and what to do about it. Work with your primary care provider and your registered dietitian to manage and reduce their effects.
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| Tips to taking meds on time | - Write down your own regular meal and medication schedule (see worksheet)
- Figure out a daily routine of eating and taking meds that work for you. Practice your routine each day.
- If you canÌt keep to your routine talk to a health care professional or even a friend about about where it gets hard. Make adjustments and try again.
- Make eating and taking meds your priority.
- Use a timer to remind you when to take your meds and when to eat.
- Use a pill box with compartments
- Use a daily check list or journal to track that you have taken each med and snack.
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- Eat to live
- Buy lots of portable snacks that don't spoil easily
- Keep food easy to reach: at the side of your bed, by the phone, by your TV or computer.
- Put a snack in your pack anytime you leave home: to work, appointments, errands, socializing
- Communicate your needs to anyone with a demand on your time. Say, for example: I need to eat first.
- Set up meals with friends during times you can eat
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